Form Nre - Non-Resident Employee Income Tax Return

FORM NRE - PAGE 2

COMPUTATION FOR LINE 2 OTHER INCOME OR DEDUCTIONS

(Need be completed only by those with taxable income other than wages, deductions from wages

due to part year employment or employee expenses and by those applying for a refund based on travel.)

13. OTHER TAXABLE INCOME EARNED IN SPRINGDALE BUT NOT REPORTED ON A W-2 (ATTACH APPROPRIATE DOCUMENTATION OF THIS AMOUNT)

(DO NOT INCLUDE INTEREST, DIVIDENDS, ANNUITIES, REFUNDS OR OTHER NON-TAXABLE INCOME RECEIVED) ………………………………………………………….

14. DEDUCTIONS

A. EMPLOYEE EXPENSES FOR WAGES WITH SPRINGDALE TAX PAID (W-2 BOX 19) OR NO LOCAL TAX PAID

(ATTACH PAGE ONE AND TWO OF FEDERAL 1040, SCHEDULE A AND FORM 2106) ……………………………………………………………………………..

$_(_________________)_

B. MOVING EXPENSES REIMBURSED BY EMPLOYER AND TAXED ON YOUR W-2

(ATTACH FEDERAL 1040 INCLUDING FORM 3903) …………………………………………………………………………………………………………………………………………………………………

$_(_________________)_

15. TOTAL OTHER INCOME OR DEDUCTIONS (LINE 13 MINUS LINE 14. ENTER THIS TOTAL ON LINE 2) ………………………………………………………………………………………………..

16. NON-RESIDENT EMPLOYEES (ATTACH A COPY OF YOUR EMPLOYER LETTER VERIFYING THE INCOME EARNED OUTSIDE OF SPRINGDALE)

A. YOUR CURRENT HOME

B. YOUR ORIGINAL HIRE DATE WITH THIS EMPLOYER:

ADDRESS:

C. EMPLOYER'S NAME AND

D. SPRINGDALE EMPLOYMENT DATES:

(BEGINNING)

SPRINGDALE ADDRESS:

(ENDING)

17. COMPUTATION OF PRORATED INCOME (BASED ON PART YEAR EMPLOYMENT OR EMPLOYMENT TRAVEL REFUNDS)

(IF YOUR INCOME WAS EARNED SOLELY IN SPRINGDALE, DO NOT COMPLETE THIS SECTION AND NOTE 100% ON LINE 3A)

365

A. TOTAL DAYS IN THE YEAR

B. NUMBER OF NON-WORK DAYS

1. SATURDAYS AND SUNDAYS (ONLY) ***

(EMPLOYEES WORKING A 4/10 WORK WEEK, NOTE DAYS OFF PER ITINERARY)

2. OTHER NON-WORK DAYS

(LEAVE WITHOUT PAY ONLY. DO NOT INCLUDE HOLIDAY, SICK,

VACATION OR PAID PERSONAL DAYS)

3. TOTAL NON-WORK DAYS

C. TOTAL DAYS WORKED IN THE YEAR

(LINE A LESS LINE B3)

D. TOTAL PAID DAYS WORKED OUTSIDE OF SPRINGDALE

(ATTACH ITINERARY NOTING DAYS AND CITIES WORKED OUTSIDE OF THE CITY.

DO NOT INCLUDE HOLIDAY, SICK, VACATION OR PAID PERSONAL DAYS) ***

E. TOTAL DAYS WORKED IN SPRINGDALE

F. PERCENTAGE OF INCOME TAXABLE TO SPRINGDALE

(LINE E ______________ DIVIDED BY LINE C ______________ = %)

(MULTIPLY THE % ON LINE F BY YOUR GROSS SPRINGDALE INCOME. THIS FIGURE AND THE

PERCENTAGE NEEDS TO BE ENTERED ON LINE 3A OF THE SPRINGDALE NRE TAX FORM)

NOTE: IF THE FOLLOWING ATTACHMENTS ARE NOT INCLUDED WITH YOUR RETURN, THE RETURN WILL NOT BE CONSIDERED A

LEGAL AND TIMELY FILED RETURN. IF FILING FOR A REFUND OR A TRAVEL REFUND AND THE PROPER ATTACHMENTS ARE NOT

INCLUDED WITH THE RETURN, THE REQUEST FOR A REFUND WILL BE DENIED AND RETURNED TO THE TAXPAYER TO RESUBMIT:

1. COPIES OF YOUR FEDERAL W-2(S), W-2C (S), YEAR TO DATE PAY STUB FOR THE YEAR, ANY APPROPRIATE

***

SCHEDULES/FORMS, AND ITINERARY (TRAVEL REFUNDS ONLY). THE ITINERARY SHOULD BE APPROVED BY YOUR

IMMEDIATE SUPERVISOR AND NOTE THE DATES AND CITIES WORKED WHEN OUT OF THE CITY OF SPRINGDALE. DO NOT

INCLUDE HOLIDAY, SICK, VACATION OR PAID PERSONAL DAYS.

2. A LETTER FROM YOUR IMMEDIATE SUPERVISOR ON COMPANY LETTERHEAD VERIFYING THAT THE ABOVE

***

COMPUTATIONS ARE CORRECT AND EXPENSE VOUCHERS AND/OR REPORTS ARE AVAILABLE FOR AUDITOR VERIFICATION.

YOUR IMMEDIATE SUPERVISOR'S NAME, TITLE AND PHONE NUMBER AS WELL AS THE CONTACT NAME AND PHONE NUMBER

FOR THE COMPANY'S HUMAN RESOURCE DEPARTMENT SHOULD BE NOTED IN THE LETTER.

3. IMMEDIATE SUPERVISOR MUST VERIFY YOUR HIRE DATE AND THE DATES EMPLOYED IN SPRINGDALE.

***

4. IMMEDIATE SUPERVISOR MUST VERIFY BY LISTING IN THE LETTER THE ACTUAL DATES TAKEN FOR HOLIDAYS,

VACATION, SICK LEAVE, PAID PERSONAL DAYS AND FOR NON-WORK DAYS TAKEN AS LEAVE WITHOUT PAY.

A municipality does not necessarily tax all items of income, nor does it necessarily allow certain items as deductions in the same manner as the State

NOTICE:

and Federal government.

NOTICE:

Unless accompanied by copies of the appropriate Federal schedules and employer verification letter and by payment of the balance of tax declared due

(line 6) and at least 25% of the estimated tax (line10), this form is not a legal final return or declaration.

NOTICE:

Failure to file a required return and/or to pay taxes due by the due date will result in imposition of penalty and interest.

All refunds issued will be reported to Federal and State taxing authorities on form 1099G as required by law effective 1/1/83.

NOTICE:

EXTENSION POLICY: Extensions may, upon request, be granted for filing of the annual return, provided an IRS extension has been secured.

EXTENSION REQUESTS MUST BE MADE IN WRITING AND RECEIVED BY THIS OFFICE BEFORE THE ORIGINAL DUE DATE OF THE RETURN.

Only those extension requests received in duplicate with a self-addressed, postpaid envelope will have a copy returned after being appropriately marked.

Form Nre - Non-Resident Employee Income Tax Return - 2009 Page 2

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